Microdiscectomy

Microdiscectomy is the most common surgical procedure used to relieve leg and/or back pain. During this procedure, a small portion of the vertebrae, the lamina, is removed, giving access to the nerves and disc. The portion of the disc is removed, relieving pressure on the nerve root.

During the surgery, a small incision is made in the center of the back; the length depends on the number of levels to be explored. After removing the disc, the incision is closed with stitches under the skin or with staples.
Patients are usually asleep for the procedure. Typically an overnight admission is usually necessary. The surgery takes about 1 hour.

Decompressive Laminectomy

Laminectomy is a surgical procedure used to remove pressure on the spinal canal and spinal nerves. Removal of bone, ligament, and disc may all be involved.
The incision is made in the center of the back. A temporary drain may be placed beneath the incision.

Surgery may take 1 to 3 hours with a hospital stay of 1 to 2 days.

Fusion

The spine is a flexible column made up of separate bones called vertebrae. Between each vertebra is a round, tire-shaped structure called an intervertebral disc. The outer ring of the disc is made of fibrous tissue and functions as a ligament. The center of the disc is gel-like and functions as a cushion or shock absorber.

Degeneration, herniation, or rupture of the intervertebral discs of the spine is a leading cause of disability, activity limitation, and economic loss. Degeneration of the cervical discs causes neck pain, and if the nerve roots are compressed, pain can be felt in the shoulder, arm, and hand. Degeneration of the lumbar discs causes back pain. If the nerve roots are compressed, pain can be felt in the buttock or leg. Nerve pressure can also cause numbness or weakness.
Initial treatment of damaged discs in the spine emphasizes medical and physical methods. Anti-inflammatory medications, muscle relaxants, and pain pills often relieve intermittent episodes of pain. Physical therapy including traction, ultrasound, hot packs, or exercises are often beneficial.

If the pain and disability remain severe and disabling after six weeks or more of medical treatment, then surgery may be considered. Surgery can be considered if the problem initially improves but returns frequently and is troublesome or a constant annoyance.

Cervical Fusion

The most common surgery to treat damaged discs in the neck is a fusion operation done in the front of the neck. This is called an anterior cervical fusion. In this operation, the worn out disc is completely removed and replaced with bone graft strong enough to support the vertebral bones. The bone graft is usually taken from the front of the pelvis or hip area. When the bone heals, the pain and disability are usually relieved.

Anterior cervical fusion is successful in achieving fusion (bone healing) in about 85% of cases and is successful in relieving pain and disability in about 90% of cases.
 
Unfortunately, removal of the block of bone from the hip area results in long standing hip pain in up to 20% of patients. Additionally, if the bone graft is not strong enough to support the patient's weight, the graft may crumble and heal in an abnormal position.

Cervical IF Cage

Beginning in 1985, Dr. John W. Brantigan designed a group of spine implants called "cages". These implants are made of a carbon fiber reinforced polymer material that is light in weight and very strong. The cages have hollow areas that are filled with a patient's own bone. Although this bone is taken from the hip area, it is taken through a smaller incision and does not require removal of a large block of bone.

This cage was found to be very successful in achieving bone fusion and provided better improvement in pain and function than previous methods in treating the problems studied. Very few patients reported discomfort from taking bone graft.
Compared with traditional fusion operations, the Cervical I/F Cage has the following potential advantages:

1.  The frequency of long-standing pain from the hip may be reduced.
2.  The frequency of collapse of the disc area may be reduced.
3.  The alignment of the vertebral bones may be improved.
4.  The rate of fusion success and relief of pain may be improved.

The Cervical I/F Cage has been used in Europe since about 1995. Initial results indicate that the implant is performing to expectations. However, the exact success rate and the nature and frequency of complications are not known.

A posterior cervical fusion uses an incision in the back of the neck. Fusion is accomplished by placing bone graft across the bones to be fused. At the same time, pressure on nerves may be relieved by removing a small piece of bone which lies over the nerve. These fusions may be strengthened with either wires or metal plates and screws.
Patients are asleep for these procedures. After completing the procedure, a small temporary drain may be placed underneath the incision. A collar is worn to hold the neck steady and provide support.

The surgery typically takes 2 to 3 hours. Patients should be able to get out of bed for short periods of exercise shortly after surgery. A hospital stay of 1 to 2 days may be required.

Lumbar Fusion

The most common types of fusion in the lower back are posterolateral fusion (PLF) and interbody fusion. Interbody fusion can be done from the back (posterior lumbar interbody fusion or PLIF), or can be done from a front incision (anterior lumbar interbody fusion or ALIF).

In the posterolateral fusion operation, bone graft is placed external to the disc to cause the spinal bones to grow together. This is the simplest type of fusion surgery, but it may not relieve back pain because it does not remove the damaged disc. Screws and plates or rods may be added to increase stability. The procedure is done to relieve back pain and to add strength and stability to the lumbar spine.

In the Posterior Lumbar Interbody Fusion operation (PLIF), the entire disc is removed, and bone graft is placed inside the disc space. The bone graft may be taken from the bone bank (transplant bone), or a patient's own bone may be used from the back of the pelvis or hip area.The bone graft must be strong enough to support the patient's body weight. When the graft bone heals, the pain and disability are usually relieved because solid bone takes the place of the painful disc. If the bone graft is crushed by the patient's own weight or if the bone fails to heal, the pain and disability may actually get worse.

Lumbar I/F Cage

Beginning in 1985, Dr. John W. Brantigan designed a group of spine implants called "cages". These implants are made of a carbon fiber reinforced polymer material that is light in weight and very strong. The cages have hollow areas that are filled with a patient's own bone. The cages make the PLIF operation more successful because they provide mechanical support and protect the bone graft while it heals.

The Lumbar I/F Cage was designed to be used through an incision in the patient's lower back (a posterior approach) and was approved in 1999 for use in the U.S. by the FDA after an extensive clinical study. When used with pedicle screws and plates, the cage was found to be very successful in achieving bone fusion. The use of pedicle screws increases the duration of surgery by less than an hour but increases the fusion success rate by about 10%. Without pedicle screw fixation, one out of ten patients will have an unnecessary failure.

 
 In posterior lumbar fusion surgery, the incision is made in the center of the back. A temporary drain may be placed beneath the incision. It is necessary to wear a brace or corset. The surgery may take 2 to 3 hours with a hospital stay of 2 to 3 days.

An anterior lumbar interbody fusion is a surgical procedure in which the lumbar spine is fused by removing one or more of the lumbar discs. The disc is replaced with a piece of the patient's bone or donor bone or fusion cages. The procedure is done to relieve back pain and to add strength and stability to the lumbar spine.

Anterior IF Cage

The Anterior I/F Cage was designed by Dr. John W. Brantigan in 1990 and uses the same principles that have been successful in the lower back. This cage has a large oval shape similar to that of the disc space itself.

 
The cage is made of carbon material that is light in weight and very strong. It has hollow areas that are filled with small pieces of a patient's own bone graft taken through a small incision in the hip area.
Compared with the traditional fusion operations, the Anterior I/F Cage has the following potential advantages:

1. The frequency of long-standing pain from the hip may be reduced.
2. The frequency of collapse of the disc area may be reduced.
3. Because a large oval cage may be more stable than side-by-side cages or bone grafts, surgery may be successful without the need for metal screws and plates.
4. Because the surgeon does not work around the spinal nerve roots, nerve pain after surgery may be reduced.

The Anterior I/F Cage has been used in Europe since about 1995. Initial results indicate that the implant is performing to expectations. However, the exact success rate and the nature and frequency of complications are not known.

In an anterior lumbar fusion, an incision is made in the abdomen to expose the front part of the spine. The exposure and closure is usually performed by a peripheral vascular surgeon or general surgeon. A temporary drain may be placed beneath the incision. It may be necessary to wear a brace or corset. The surgery may take 2-3 hours with a hospital stay of 2 to 3 days.

Scoliosis

Scoliosis is a condition when the spine is curved. Surgery may be needed to correct the spinal curvature.

Procedures to correct scoliosis are tailored to the patient's curve. Surgery may be from the front, back or a combination of both. Once the curve is corrected, it is held in place using a system of rods, screws and wires. Bone graft is used to help the fused portion of the spine solidify.

The surgery may take anywhere from 4 to 12 hours. Recovering in the hospital can take several days.

Interdiscal Electrothermal Therapy (IDET)

Lower back pain is one of the most common ailments affecting people at some point in their lives. For most people, the pain resolves quickly, perhaps aided by rest, therapeutic exercise, or medication. But for many, the pain is a result of a disc degeneration process that is prolonged, severe, and for which conventional treatment does not provide the needed relief. It is for these chronic lower back pain sufferers that the SpineCATH IntraDiscal ElectroThermal (IDET) therapy was developed.

With age, or due to injury, cracks, or fissures may develop in the wall of the intervertebral disc. Filled with small nerve endings and blood vessels, these fissures are a chronic source of pain in many patients. Additionally, the inner disc tissue (nucleus) will frequently bulge (herniated) into these fissures in the outer region of the disc, likewise stimulating pain sensors within the disc.

 
SpineCATH IDET therapy is a minimally invasive treatment in which the physician applies controlled levels of thermal energy (heat) to a broad section of the affected disc wall. This heat contracts and thickens the collagen of the disc wall, and raises the temperature of the nerve endings. Therapy may result in contraction or closure of the disc wall fissures, a reduction in the bulge of the inner disk material, and a desensitization of the pain sensors within the disc.

Nucleoplasty

Back problems are among the most common ailments affecting adults, and are potentially one of the most debilitating. For most people, back problems resolve quickly, aided by rest, therapeutic exercise, or medication. For some however, back problems resulting from disc herniation are prolonged and severe, and do not respond to conventional treatments.

Nucleoplasty is a minimially invasive procedure developed for patients with contained herniated discs. In the Nucleoplasty procedure, the physician removes tissues and applies controlled levels of thermal energy (heat) to the disc.

Nucleoplasty is usually performed on an outpatient basis. Local anesthesia and mild sedation may be used to reduce discomfort during the procedure. You will be awake to enable you to provide important feedback to your physician. With the guidance of X-ray images, your physician will first advance a needle into the disc. A specialized device, known as the Perc-D SpineWand, will then be introduced through the needle and into the disc. Nucleoplasty consists of creating a series of channels in your disc and then thermally treating the tissue immediately adjacent to the Perc-D SpineWand. The procedure should take less than an hour.

 
 Access needle and SpineWand in disc  Close-up view